L’infection à VIH-1 est associée à une forte déplétion des lymphocytes T CD4+ à polarisation Th17 au niveau des tissus lymphoïdes associés aux muqueuses intestinales (GALT, gut-associated lymphoid tissues). Ceci conduit à la translocation microbienne, qui est une cause d’activation immunitaire chronique et de progression de la maladie. Les cellules épithéliales (CE) jouent un rôle critique dans le maintien de l’intégrité et de l’homéostasie au niveau des muqueuses intestinales via le recrutement des cellules de l’immunité innée (e.g., neutrophiles) et adaptative (e.g., cellules Th17). Les neutrophiles produisent des molécules antivirales (e.g., défensines-) et ont la capacité de limiter la réplication virale au niveau des muqueuses. Les cellules Th17 jouent un double rôle lors de l’infection à VIH. Elles contribuent d’une part à la défense contre différents pathogènes opportunistes en augmentant, via la production d’IL-17, la capacité des CE à attirer les cellules Th17 et les neutrophiles. D’autre part, les cellules Th17 jouent un rôle délétère en tant que cibles de réplication virale et sources de cytokines pro-inflammatoires. La fréquence des cellules Th17 est diminuée dans les GALT mais pas dans les poumons des patients infectés par le VIH, suggérant qu’il existe des mécanismes différents par lesquels les cellules Th17 sont recrutées vers ces sites anatomiques. Nous avons testé l’hypothèse selon laquelle le VIH interfère avec la capacité des CE intestinales et non pas pulmonaires à produire des chimiokines (CK) responsables de l’attraction des cellules Th17 et des neutrophiles. Nous avons démontré que les CE intestinales et pulmonaires produisent des CK spécifiques pour les cellules Th17 (CCL20) et les neutrophiles (CXCL8) en réponse à des stimuli pro-inflammatoires tels que l’IL-1 et le TNF-. Le TNF- agit en synergie avec l’IL-17, un « signal de danger » récemment identifié, et augmente la capacité des CE intestinales mais pas pulmonaires à produire la chimiokine CCL20. Cette synergie s’explique par l’augmentation préférentielle de l’expression du récepteur à l’IL-17 à la surface des CE intestinales suite à la stimulation par le TNF-. L’exposition au VIH n’affecte pas la production de CCL20 et de CXCL8 par les CE intestinales, mais altère la capacité des CE alvéolaires à produire ces chimiokines en accord avec la permissivité sélective de ces dernières à l’infection par le VIH. En conclusion, nos résultats démontrent que (i) le VIH n’interfère pas directement avec la capacité des CE intestinales à recruter des cellules Th17 et des neutrophils et que (ii) la production de CCL20 par ces cellules est dépendantes de la synergie entre le TNF- et l’IL-17. Ainsi, la déplétion des cellules Th17 et la pénurie en IL-17 dans les GALT des sujets infectés pourrait causer de façon préférentielle des altérations fonctionnelles au niveau des CE intestinales, se traduisant par l’altération du recrutement des cellules Th17 en réponse au CCL20. / The HIV-1 infection is associated with a severe loss of CD4+ T-cells with Th17 polarization from the gut-associated lymphoid tissues (GALT). These alterations lead to microbial translocation, which is a cause of chronic immune activation and disease progression in HIV-infected subjects. Epithelial cells (EC) play a critical role in maintaining mucosal integrity and homeostasis in the GALT by mechanisms including recruitment of innate (e.g., neutrophils) and adaptive immunity cells (e.g., Th17 cells). Neutrophils produce antiviral molecules (e.g., -defensins) that may limit HIV replication at mucosal sites. Th17 cells play a dual role in HIV pathogenesis. Th17 cells contribute to the defence against different opportunistic pathogens by increasing the ability of epithelial cells to attract neutrophils in an IL-17-dependent manner. On the other hand, Th17 cells play a deleterious role in HIV pathogenesis as they are sites of productive viral replication and a source of pro-inflammatory cytokines. The frequency of Th17 cells is decreased in the GALT but not in the lungs of HIV-infected individuals, suggesting distinct mechanisms of Th17 recruitment in these anatomic sites in the context of HIV pathogenesis. In this manuscript we tested the hypothesis that HIV differentially interfere with the ability of intestinal but not pulmonary EC to produce chemokines that attract Th17 cells and neutrophils. We demonstrated that both intestinal and pulmonary EC produce chemokines that specifically attract Th17 cells (CCL20) and neutrophils (CXCL8) upon stimulation with the pro-inflammatory cytokines IL-1 and TNF- . TNF-α acted in synergy with IL-17, a recently identified « danger signal », and increases the capacity of intestinal but not pulmonary EC to produce CCL20. This synergistic effect can be explained by the preferential upregulation of IL-17 receptor expression on intestinal EC upon TNF- stimulation. The exposure of intestinal EC to HIV did not affect their ability to produce CCL20 and CXCL8; however, exposure to HIV altered the production of these chemokines by alveolar EC, consistent with their selective permissiveness to infection. In conclusion, our results demonstrate that (i) HIV does not interfere directly with the ability of intestinal EC to attract Th17 cells and neutrophils and that (ii) the ability of intestinal EC to recruit the Th17 cells via CCL20 production is selectively dependent on the synergy between TNF- and IL-17. Thus, the depletion of Th17 cells and the shortage in IL-17 in the GALT of HIV-infected subjects may preferentially lead to functional alterations of the intestinal barrier resulting by the alteration of Th17 recruitment in response to CCL20.

<p>Diss. (sammanfattning) Umeå : Umeå universitet, 2001. Härtill 6 uppsatser.</p> / digitalisering@umu

Background The role of social capital for promoting health has been extensively studied in recent years but there are few attempts to investigate the possible influence of social capital on HIV prevention,particularly in developing countries. The overall aims of this thesis are to investigate the links between social capital and HIV infection and to contribute to the theoretical framework of the role of social capital for HIV prevention. Methods Key informant interviews with leaders of organizations, networks, social groups and communities and focus group discussions with members and non-members of the social groups and networks were conducted to map out and characterize various forms of social capital that may influenceHIV prevention. A quantitative community survey was carried out in three case communities toestimate the influence of social capital on HIV risk behaviors. A cross-sectional survey was conducted to estimate the HIV prevalence in the urban district representing a high HIV prevalence zone to determine the association between social capital and HIV infection. Main findings In early 1990’s many of the social groups in Kagera region were formed because of poverty and many AIDS related deaths. This formation of groups enhanced people’s social and economic support to group members during bereavement and celebrations as well as provided loans that empowered members economically. The social groups also put in place strict rules of conduct, which helped to create new norms, values and trust, which influenced sexual health andthereby enhanced HIV prevention. Formal organizations worked together with social groups and facilitated networking and provided avenues for exchange of information including healtheducation on HIV/AIDS. Individuals who had access to high levels of structural and cognitive social capital were more likely to use condoms with their casual sex partners compared to individuals with access to low levels. Women with access to high levels of structural social capital were more likely to use condoms with casual sex partners compared to those with low levels. Individuals with access to low levels of structural social capital were less likely to be tested for HIV compared to those with access to high levels. However, there was no association between access to cognitive social capital and being tested for HIV. Individuals who had access to low levels of both structural and cognitive social capital were more likely to be HIV positive compared to individuals who had access to high levels with a similar pattern among men and women. Conclusion This thesis indicates that social capital in its structural and cognitive forms is protective to HIV infection and has played an important role in the observed decline in HIV trends in the Kagera region. Structural and cognitive social capital has enabled community members to decrease number of sexual partners, delay sexual debut for the young generation, reduce opportunities for casual sex and empower community members to demand or use condoms. It is recommended that policy makers and programme managers consider involving grassroots’ social groups and networks in the design and delivery of interventions strategies to reduce HIV transmission.

ABSTRACT An Examination of the Differences in Risk Factors and their Association with Variations in HIV Prevalence between Cameroon, Cote d’Ivoire, and Senegal (Under the direction of RICHARD ROTHENBERG, M.D., M.P.H. FACULTY MEMBER) Background: Extensive evidence suggests there are large variations in the prevalence of HIV infection among Sub-Saharan African countries. Some studies associated these variations in HIV prevalence to differences in the rate of HIV spread while others attributed the variations to risky sexual behaviors. The purpose of this study was to examine differences in risk factors for HIV infection between Cameroon, Cote d’Ivoire, and Senegal, to determine the association between HIV status and risk factors within and among countries, and identify best predictive risk factors that help explain variations in HIV prevalence. Methods: A cross-sectional study was conducted using nationally representative data from The Demographic and Health Surveys Program. Population-based samples of adults aged 15-49 representing 21,878 in Cameroon (2011), 14,682 in Cote d’Ivoire (2011-2012), and 20,102 in Senegal (2010-2011) were used in the study. Descriptive analysis and binary logistic regression were performed using IBM Statistical Package for the Social Sciences. Odds ratios and 95% confidence interval were calculated, and models were explored. Results: There are statistically significant (p Conclusion: There are differences in risk factors among the three countries and these differences can explain some of the variations in HIV prevalence. Further research is necessary to help capture variations in HIV prevalence that cannot be explained by differences in risk factors. These findings will help advance prevention efforts. KEYWORDS: HIV, AIDS, risk factors, HIV infection, HIV prevalence, Sub-Saharan Africa

<p>&nbsp / </p> <p align="left">One of the most common HIV-associated opportunistic infections is candidiasis, caused by <i><font face="TimesNewRoman,Italic">Candida albicans </font></i><font lang="KO" face="TimesNewRoman">or other </font><i><font face="TimesNewRoman,Italic">Candida </font><font lang="KO" face="TimesNewRoman">species. In immune suppressed subjects, this commensal organism can cause an increase in patient morbidity and mortality due to oropharyngeal or systemic dissemination. Limited information exists on the prevalence and antifungal susceptibility of </font><i><font face="TimesNewRoman,Italic">Candida </font><font lang="KO" face="TimesNewRoman">species in the African continent, the most HIV-affected region globally and home to new and emerging drug resistant </font><i><font face="TimesNewRoman,Italic">Candida </font><font lang="KO" face="TimesNewRoman">species. The mechanisms of </font><i><font face="TimesNewRoman,Italic">Candida </font><font lang="KO" face="TimesNewRoman">drug resistance in the African continent have also not been described. In this study, 255 </font><i><font face="TimesNewRoman,Italic">Candida </font><font lang="KO" face="TimesNewRoman">species isolated from the oral mucosa of HIV-positive South African and Cameroonian patients were identified using differential and chromogenic media and their drug susceptibility profiles tested using the disk diffusion method and the TREK Sensititre system, an automated broth microdilution method. </font><i><font face="TimesNewRoman,Italic">Candida </font><font lang="KO" face="TimesNewRoman">cell wall fractions were run on SDSPAGE and HPLC-MS with the aim of identifying peptides specifically expressed by antifungal drug resistant isolates. Comparisons between the two groups of isolates revealed differences in </font><i><font face="TimesNewRoman,Italic">Candida </font><font lang="KO" face="TimesNewRoman">species prevalence and drug susceptibility with interesting associations observed between specific drug resistance and duration of ARV therapy. This study showed that fluconazole, the drug of choice for the treatment of candidiasis in the African continent, is not an effective therapy for most cases of </font><i><font face="TimesNewRoman,Italic">Candida </font><font lang="KO" face="TimesNewRoman">infection, and suggests that regional surveillance be implemented in the continent. A multiple-drug resistant </font><i><font face="TimesNewRoman,Italic">Candida </font><font lang="KO" face="TimesNewRoman">strain was identified in this study, a finding that has not previously been documented. The use of proteomics tools allowed for the identification of peptides involved in drug resistance and the elucidation of </font><i><font face="TimesNewRoman,Italic">Candida </font><font lang="KO" face="TimesNewRoman">colonization mechanisms in HIV-infected African patients.</font></i></i></i></i></i></i></i></i></i></i></p>

<p>&nbsp / </p> <p align="left">One of the most common HIV-associated opportunistic infections is candidiasis, caused by <i><font face="TimesNewRoman,Italic">Candida albicans </font></i><font lang="KO" face="TimesNewRoman">or other </font><i><font face="TimesNewRoman,Italic">Candida </font><font lang="KO" face="TimesNewRoman">species. In immune suppressed subjects, this commensal organism can cause an increase in patient morbidity and mortality due to oropharyngeal or systemic dissemination. Limited information exists on the prevalence and antifungal susceptibility of </font><i><font face="TimesNewRoman,Italic">Candida </font><font lang="KO" face="TimesNewRoman">species in the African continent, the most HIV-affected region globally and home to new and emerging drug resistant </font><i><font face="TimesNewRoman,Italic">Candida </font><font lang="KO" face="TimesNewRoman">species. The mechanisms of </font><i><font face="TimesNewRoman,Italic">Candida </font><font lang="KO" face="TimesNewRoman">drug resistance in the African continent have also not been described. In this study, 255 </font><i><font face="TimesNewRoman,Italic">Candida </font><font lang="KO" face="TimesNewRoman">species isolated from the oral mucosa of HIV-positive South African and Cameroonian patients were identified using differential and chromogenic media and their drug susceptibility profiles tested using the disk diffusion method and the TREK Sensititre system, an automated broth microdilution method. </font><i><font face="TimesNewRoman,Italic">Candida </font><font lang="KO" face="TimesNewRoman">cell wall fractions were run on SDSPAGE and HPLC-MS with the aim of identifying peptides specifically expressed by antifungal drug resistant isolates. Comparisons between the two groups of isolates revealed differences in </font><i><font face="TimesNewRoman,Italic">Candida </font><font lang="KO" face="TimesNewRoman">species prevalence and drug susceptibility with interesting associations observed between specific drug resistance and duration of ARV therapy. This study showed that fluconazole, the drug of choice for the treatment of candidiasis in the African continent, is not an effective therapy for most cases of </font><i><font face="TimesNewRoman,Italic">Candida </font><font lang="KO" face="TimesNewRoman">infection, and suggests that regional surveillance be implemented in the continent. A multiple-drug resistant </font><i><font face="TimesNewRoman,Italic">Candida </font><font lang="KO" face="TimesNewRoman">strain was identified in this study, a finding that has not previously been documented. The use of proteomics tools allowed for the identification of peptides involved in drug resistance and the elucidation of </font><i><font face="TimesNewRoman,Italic">Candida </font><font lang="KO" face="TimesNewRoman">colonization mechanisms in HIV-infected African patients.</font></i></i></i></i></i></i></i></i></i></i></p>

The distinctive feature of the Human Immunodeficiency Virus (HIV) epidemic in the 21st century is the burden it places on women. Scientists believe that the best opportunities for successful interventions to prevent sexual HIV transmission lie in the initial stages of infection at the portal of entry, the genital tract (GT), which offers the greatest host advantages and viral vulnerabilities. However, understanding of the correlates of protection/vulnerability and innate immunity at the portal of entry is poor. First and foremost, there is no agreement about which GT sub-compartment is the primary site of HIV/SIV infection. Second, the epithelium, previously studied solely for its function as a barrier, has hardly been investigated for its role in innate immunity in the context of SIV/HIV infection. MIP-3&alpha;, a chemokine secreted by epithelial cells, was previously proposed to have a role in amplifying the early Simian Immunodeficiency Virus (SIV) infection events in the GT of female macaques. Specifically, MIP-3&alpha; was shown to be secreted by epithelial cells of the endocervix, accumulating subepithelially within the first 24 hours post exposure, following deposition of an intravaginal inoculum of SIV. Similar studies in humans have not been reported. We hence undertook to study MIP-3&alpha; for its role in early HIV infection events in the endocervix of humans. In order to achieve this, we first characterised MIP-3&alpha; constitutive secretion patterns in different sub-compartments of the GT before proceeding to determine its induced secretion patterns, stimulating with HIV-1 and various Toll-like receptor ligands. For completeness we determined constitutive and induced secretion patterns of multiple soluble proteins (SPs) and antimicrobial peptides (AMPs) in the endocervices of humans and macaques. The GT being an immunohormonal system, we further studied the influence of endogenous hormonal changes on the stability of MIP-3&alpha; and that of other innate immune markers. We quantified MIP-3&alpha; with a sandwich Elisa, and SPs and AMPs with the Luminex multiplex bead assay. Our results showed that the GT is a rich source of MIP-3&alpha; with its levels being among those of the highest SPs in the GT. Constitutive levels were highest in the endocervical sub-compartment of all the sub-compartments studied. Further, the GT is an inflammatory environment, which would explain the high levels of MIP-3&alpha;. The primary driver of MIP-3&alpha; levels appears to be inflammation rather than hormonal levels. MIP-3&alpha; levels are significantly higher in the GT of humans than in macaques. There was no evidence that MIP-3&alpha; levels are elevated on exposure to HIV and SIV in humans and macaques, respectively. We therefore concluded that since the endocervix is unlikely to respond to HIV/SIV by secreting MIP-3&alpha; in vivo, contrary to the previous reports, MIP-3&alpha; is hence not a key player in amplifying early events in infection. And as such, it should not be a prime target for preventive therapy. Further, the human GT having a pre-existing inflammatory profile may explain the high rates of HIV sexual transmission. Lastly, we concluded that the infection mechanisms described in the macaque model (i.e. the 'outside-in' signaling) are likely not required for human infection.

Philosophiae Doctor - PhD / One of the most common HIV-associated opportunistic infections is candidiasis, caused by Candida albicans or other Candida species. In immune suppressed subjects, this commensal organism can cause an increase in patient morbidity and mortality due to oropharyngeal or systemic dissemination. Limited information exists on the prevalence and antifungal susceptibility of Candida species in the African continent, the most HIV-affected region globally and home to new and emerging drug resistant Candida species. The mechanisms of Candida drug resistance in the African continent have also not been described. In this study, 255 Candida species isolated from the oral mucosa of HIV-positive South African and Cameroonian patients were identified using differential and chromogenic media and their drug susceptibility profiles tested using the disk diffusion method and the TREK Sensititre system, an automated broth microdilution method. Candida cell wall fractions were run on SDSPAGE and HPLC-MS with the aim of identifying peptides specifically expressed by antifungal drug resistant isolates. Comparisons between the two groups of isolates revealed differences in Candida species prevalence and drug susceptibility with interesting associations observed between specific drug resistance and duration of ARV therapy. This study showed that fluconazole, the drug of choice for the treatment of candidiasis in the African continent, is not an effective therapy for most cases of Candida infection, and suggests that regional surveillance be implemented in the continent. A multiple-drug resistant Candida strain was identified in this study, a finding that has not previously been documented. The use of proteomics tools allowed for the identification of peptides involved in drug resistance and the elucidation of Candida colonization mechanisms in HIV-infected African patients.

Introdução As deficiências de vitaminas, verificadas em indivíduos com HIV/Aids em terapia antirretroviral de alta potência (HAART) têm sido associadas à piora do curso clínico da doença e maior risco de mortalidade. Objetivo Mostrar a distribuição das concentrações séricas de vitaminas A e E, e beta-caroteno em adultos com infecção pelo HIV/Aids e estudar a associação de suas concentrações, segundo diferentes esquemas de HAART. Métodos Foram selecionados 182 adultos de 20 a 59 anos de idade, de ambos os sexos, com HIV/Aids em HAART estável por no mínimo 6 meses, e com níveis de linfócitos T-CD4+ 200 células/mm3. Os indivíduos foram divididos em três grupos por esquema de HAART utilizado: inibidores de transcriptase reversa análogos de nucleosídeo (ITRN) associados a inibidores de transcriptase reversa não análogos de nucleosídeo (ITRNN); ITRN associada a inibidores de protease (IP); ITRN associadas a outras classes (inibidores de fusão, inibidores de integrase, inibidores de entrada e IP associada a essas medicações). A determinação dos micronutrientes foi realizada por cromatografia líquida de alta eficiência. Foram verificadas variáveis sócio-demográficas e econômicas, estilo de vida, história da doença, uso de medicações e variáveis antropométricas e laboratoriais. Para medir os efeitos das variáveis explanatórias (esquemas de tratamento, tempo de uso e adesão ao último esquema) sobre cada variável resposta (retinol, alfa-tocoferol e beta-caroteno), foram realizadas análises de regressão linear múltipla. Sexo, idade, escolaridade, tabagismo, prática de atividade física, tempo de infecção por HIV, presença de comorbidades, relação cintura-quadril e níveis de linfócitos T-CD4+ e colesterol foram usadas como variáveis de controle. Resultados Foram encontradas concentrações deficientes e baixas de vitaminas A (<0,70Nmol/L) e E (16,2Nmol/L), e beta-caroteno (<0,13Nmol/L) em 3,83 por cento, 18,68 por cento e 23,62 por cento dos indivíduos, respectivamente. Menores concentrações médias de vitamina E foram observadas em indivíduos em uso de ITRN associado a classes mais recentes de antirretrovirais (p= 0,037). Indivíduos com maiores índices de relação cintura-quadril apresentaram maiores concentrações de retinol (p=0,012) e menores concentrações de beta-caroteno (p=0,036). Foram também observadas associações positivas, pequenas e estatisticamente significantes entre as concentrações médias de retinol, alfatocoferol e beta-caroteno com os níveis de colesterol. Conclusão Os resultados sugerem que as alterações nas concentrações de vitamina A e E, e beta-caroteno podem estar relacionadas a múltiplos fatores, incluindo os esquemas de terapia antirretroviral / Introduction Deficiency of vitamins found in individuals with HIV/AIDS on highly active antiretroviral therapy (HAART) has been associated with an increased risk of disease progression and mortality. Objective To show the distribution of serum concentrations of vitamins A and E and beta-carotene in adults with HIV/AIDS, and to study the association of their concentrations, according to different regimens of HAART. Methods We selected 182 men and women aged 20-59 years with HIV/AIDS on stable HAART for at least six months and with levels of CD4+ T-lymphocytes 200 cells/mm3. Individuals were divided into three groups according to the HAART regimen used: nucleoside reverse transcriptase inhibitors (NRTI) combined with nonnucleoside reverse transcriptase inhibitors (NNRTI); NRTI combined with protease inhibitors (PI); NRTI combined with other classes (fusion inhibitors, integrase inhibitors, entry inhibitors, and PI associated with these medications). Determinations of vitamins A and E and beta-carotene were performed by high-performance liquid chromatography. Socio-demographic and economic variables, lifestyle, disease history, medication use, and anthropometric and laboratory variables were assessed. Multiple regression analyses were used to measure the effects of the explanatory variables (treatment regimens, duration and adherence to the last treatment regimen) on each response variable (retinol, alpha-tocopherol and beta-carotene). Sex, age, education, smoking, physical activity, duration of HIV infection, comorbidity, waist-to-hip ratio and levels of CD4+ T-lymphocytes and cholesterol were used as control variables. Results Deficient and low concentrations of vitamin A (<0,70Nmol/L) and E (16,2Nmol/L), and betacarotene (<0,13Nmol/L) were 3,83 per cent, 18,68 per cent and 23,62 per cent, respectively. Lower concentrations of vitamin E (p= 0,037) were observed in individuals using NRTI combined with the most recent classes of antiretrovirals. Individuals who had higher measurements of waist-to-hip ratio presented higher concentrations of retinol (p= 0,012) and lower concentrations of betacarotene (p=0,036). We also observed positive small statistically significant associations between mean concentrations of retinol, alpha-tocopherol and beta-carotene with cholesterol levels. Conclusion The results suggest that changes in the concentrations of vitamins A and E and beta-carotene may be related to multiple different factors, including antiretroviral therapy regimens

La malnutrition est une pathologie récurrente en Afrique, qui touche particulièrement les enfants et adolescents vivant avec le VIH. Le Sénégal a été l’un des premiers pays africains à mettre en œuvre un programme national d’accès aux antirétroviraux à partir de 1998. Néanmoins, comme dans la majorité des pays, la prise en charge pédiatrique a connu un retard par rapport à celle des adultes. La malnutrition et l’infection à VIH agissent en interaction et aggravent le risque de morbidité et de mortalité des enfants. Pour autant, les recommandations internationales se sont surtout intéressées à la prise en charge de la malnutrition chez les enfants de moins de cinq ans. Il existe peu de directives concernant les modalités de récupération nutritionnelle chez les enfants de plus de cinq ans et les adolescents infectés par le VIH.C’est dans ce contexte qu’a été mise en place l’étude Snac’s qui avait pour objectif d’évaluer l’efficacité et l’acceptabilité de la récupération nutritionnelle ambulatoire par l’administration d’Aliments prêts à l’emploi (APE) chez les enfants et adolescents infectés par le vih dans 12 sites de prise en charge à Dakar et dans les régions du Sénégal. Cette thèse a pour objectif d’évaluer, dans le cadre de cette étude 1/l’acceptabilité d’un dispositif innovant d’information des enfants et des parents pour la participation à la recherche 2/ l’acceptabilité de l’intervention de récupération nutritionnelle chez les enfants et adolescents et d’identifier les facteurs et obstacles à cette acceptabilité 3/ l’acceptabilité de l’intervention chez les soignants impliqués dans l’étude.Trois enquêtes ont été menées au cours du projet Snac’s, dans les deux sites de Dakar et les dix sites régionaux auprès des enfants, des parents/tuteurs et des professionnels de santé. Les entretiens avec les enfants en succès ou en échec de traitement de la malnutrition et avec les parents se sont déroulés par focus group. Ils ont concerné 112 enfants au moment de l’inclusion et 71 enfants au moment de la sortie de l’étude. Des entretiens individuels ont concerné 30 professionnels de santé.Le Dispositif standardisé d’information à la recherche (dsir) avait pour intérêt de standardiser et rendre facilement compréhensible l’information des participants. Il a été apprécié par les enfants/adolescents, et par les parents/tuteurs. 68 % des parents/tuteurs et 58 % des enfants/adolescents, ont répondu correctement à au moins 7/8 questions. La notion qui a été la moins bien comprise par les parents/tuteurs et les enfants/adolescents était le droit de quitter l’étude, avec des taux respectifs de réponses correctes de 54 % et 36 %. L’enquête sur l’acceptabilité à permis d’identifier trois déterminants qui peuvent représenter un obstacle à l’adhésion des enfants/adolescents à une prise en charge nutritionnelle ambulatoire à base d’ape : le dégoût des ape, les effets secondaires et la durée de l’attente avant la consultation. Les entretiens avec les équipes soignantes ont mis en évidence les difficultés rencontrées dans la prise en charge du VIH pédiatrique. Les analyses ont montré une bonne acceptabilité de l’intervention, mais une incertitude quant à la possibilité de la pérenniser à la fin du projet.Ce travail a permis d’expérimenter la mise en place du dsir, qui s’avère intéressant même s’il demande à être amélioré. Il a permis de décrire les difficultés et les enjeux de la prise en charge de l’infection à vih pédiatrique notamment en région, qui constituent l’environnement des interventions de récupération nutritionnelle. Les résultats de cette étude montrent que le dispositif de récupération nutritionnelle ambulatoire est acceptable par les principaux acteurs (enfants/adolescents, parents/tuteurs et équipes soignantes), mais que sa pérennisation n’est envisageable qu’avec l’appui et l’engagement des autorités sanitaires, la mise en place d’un approvisionnement régulier en ape et d’un accompagnement, notamment financier, adéquat. / Malnutrition is a recurrent disease in Africa, particularly affecting children and adolescents living with HIV. Senegal was one of the first African countries to implement a national program for access to antiretrovirals (ISAARV) from 1997. Nevertheless, as in most countries, pediatric in relation to that of adults. Malnutrition and HIV infection interact and increase the risk of child morbidity and mortality. However, international recommendations have focused on the management of malnutrition among children under five years of age. There are few guidelines for nutritional recovery in children over five years of age and adolescents infected with HIV.It was in this context that the Snac's study was set up to evaluate the effectiveness and acceptability of ambulatory nutrition recovery through the administration of Ready-to-Use Foods ) in HIV-infected children and adolescents in 12 treatment sites in Dakar and Senegal. The objective of this thesis is to evaluate, within the framework of this study 1 / the acceptability of an innovative information system for children and parents for participation in research 2 / the acceptability of the recovery intervention nutritional status in children and adolescents and to identify factors and barriers to acceptability 3 / the acceptability of the intervention among the caregivers involved in the study.Three surveys were conducted during the Snac's project at the two sites in Dakar and the ten regional sites for children, parents / caregivers and health professionals. Interviews with children on successful or unsuccessful treatment of malnutrition and with parents were conducted by focus group. They included 112 children at the time of inclusion and 71 children at the time of study exit. Individual interviews were held with 30 healthcare professionals. The quantitative data were processed with SAS and qualitative data using the Dedoose ™ software.Results: The Standardized Information System for Research (dsir) had the advantage of standardizing and making participants' information easily understandable. It was enjoyed by children / teenagers, and by parents / guardians. 68% of parents / guardians and 58% of children / adolescents, correctly answered at least 7/8 questions. The notion that was least well understood by parents / guardians and children / adolescents was the right to leave the study, with respective rates of correct answers of 54% and 36% respectively. The Acceptability Survey identified three determinants that may represent an obstacle to adherence of children / adolescents to ambulatory ape-based nutritional management: ape disgust, adverse effects, and the duration of the waiting period before the consultation. Interviews with healthcare teams highlighted the difficulties encountered in the management of pediatric HIV. The analyzes showed a good acceptability of the intervention, but an uncertainty as to the possibility of perpetuating it at the end of the project.This work allowed us to experiment with the implementation of the desire, which is interesting even if it needs to be improved. It made it possible to describe the difficulties and the stakes of the management of the pediatric hiv infection in particular in the region, which constitute the environment of the interventions of nutritional recovery. The results of this study show that the ambulatory nutritional recovery device is acceptable to the main actors (children / adolescents, parents / caregivers and healthcare teams), but that its sustainability is only possible with the support and commitment health authorities, the establishment of a regular supply in ape and adequate financial and financial support.